1. Field of the Disclosure
The present disclosure relates to diagnosis of patients, and more particularly, to a method and system for cutaneous medicine diagnostics.
2. Description of the Related Art
In the background art, there is lacking a system that aggregates patient's own observations, signs and symptoms, clinical data, and histopathology data for a patient's dermatological conditions. Conventional medical practice for tracking and diagnosing of dermatological conditions is typically confined to a review of lesions during periodic office visits to the dermatologist. The disadvantage of such periodic office consultations is that it fails to aggregates patient's own observations, signs and symptoms, clinical data, and histopathology data for a patient's dermatological conditions. Moreover, such conventional systems are incapable of integrating all of the above data into a physician's diagnosis, which leads to disadvantages to the patient, to the patient's treating physician, and to a consulting pathologist.
First, the conventional office consultation procedure for diagnosing patients is static, i.e., they only can compare against a prior office consultation and does not provide the benefit of historical changes to the lesion between consultations. There is limited availability of sequential pictorial and clinical information about disease progression in the same patient in the background art: for the training of physicians, particularly dermatologists and dermatopathologists, this is a distinct disadvantage. Dermatological lesions evolve over time. Lesions acquire and lose key features that influence a diagnosis. A dermatologist who encounters a lesion very early or very late in the evolution of that lesion may be less likely to or even unable to diagnose the lesion accurately, particularly after a single encounter and in some cases even with histological support. Dermatologists are taught to recognize the different stages of a lesion by reviewing photographs of lesions from the same disease, present and documented most often in different patients, but at various stages of development. The evolution of a given lesion is now represented primarily as composite sequential photographs from different patients. Within the confines of systems of the background art, the logistics of documenting the same lesion in one patient over the course of its evolution are difficult to overcome due to the variance with which patients seek or can receive medical attention versus the pace at which lesions from different categories change. An evolving lesion can be very difficult to diagnose if the key diagnostic features wax and wane as they often do, or if the key diagnostic features are partially developed or in regression at the time of evaluation. This renders dermatology more difficult to learn for clinicians and pathologists alike, and limits the accuracy of diagnoses, particularly in the early and late stages of many skin conditions. Patients are sometimes, therefore, required to make multiple visits, or to begin a possibly-erroneous presumptive treatment before an accurate diagnosis is reached.
Second, there is lacking in the background art a system that tracks changes over time in a skin lesion, as related to a scope of differential diagnosis of the lesion by the clinician. Sequential photographs may be useful for following gross changes, but have a shortcoming in that they can mask relatively small, subtle changes due to variable magnification and focal point, making evaluation of lesion progression more difficult. Although patients might be very interested in their own skin care, patients have no easy way of monitoring all their skin changes or lesions all the time, in a fashion that rewards the patient for being involved in their own skin care or that brings additional descriptive and sometimes key diagnostic information to the dermatologist or pathologist. This is especially so when an office visit is delayed and the diagnostic features of the lesion are no longer present at the time of evaluation as is the case of many inflammatory lesions. In addition, many patients lack a detailed medical vocabulary to describe succinctly, skin changes in a way that would be additionally useful to a dermatologist in resolving a difficult differential diagnosis.
Third, the background art lacks a mechanism for patients to communicate with, interact with or choose the best or a preferred dermatopathologist to initially interpret the stained tissue sections produced from their biopsy in order to render a diagnosis. Patients currently do not have a simple, reliable way to evaluate and choose the best laboratory to process their skin biopsies or evaluate or choose the ideal dermatopathologist for rendering a diagnosis, in the same way that they evaluate and choose a dermatologist, surgeon or primary care doctor. The dermatopathologist renders the diagnosis on which medical treatment, surgical procedures and prognoses are based. Currently, in many cases, third party payers (e.g., insurance providers) decide where the patient's biopsy specimens are sent for laboratory processing and therefore by whom dermatopathology consultation is performed, and this is often based on exclusive, pre-negotiated contracts between the third party payers and the large national laboratories that employ a growing number of dermatopathologists. Alternatively the dermatologist may decide where the patient's biopsies are sent based on prior relationships with the dermatopathologists, relationships often established during their residency and fellowship, or based on the reputation and track record of the dermatopathologist. Dermatopathologists who practice independently have no easy way to demonstrate their advanced training or expertise directly to the patient. Communication between the dermatopathologist and with the ordering dermatologist is also limited to telephone calls and faxes, email or online lookup of results, all of which are inconvenient in that they require interruption of workflow by either the pathologist or the dermatologist. Further, dermatopathologists have almost no way of seeing the evolution of a skin lesion or the static lesion at the time it is biopsied, unless the dermatologist is inclined to take a photograph and email it to the dermatopathologist or upload it to a laboratory information system, which is a non-trivial addition to the logistics of a patient's visit. A lack of this clinical information can further increase the chances of a late or improper diagnosis. This gross appearance of a lesion is lost at the time of the biopsy if not captured by photography, due to changes in the devitalized tissue as well as other changes secondary to chemical processing of the tissue in preparation for the microscopic evaluation.
Fourth, the background art leaves practitioners limited in their ability to undertake remote diagnosis and advisement of patients who cannot be physically present with a clinician for a skin exam.